PMID- 11908741
OWN - NLM
STAT- MEDLINE
DCOM- 20030729
LR  - 20190116
IS  - 1042-8194 (Print)
IS  - 1026-8022 (Linking)
VI  - 43
IP  - 1
DP  - 2002 Jan
TI  - Unrelated donor leukocyte infusions to treat relapse after unrelated donor bone 
      marrow transplantation.
PG  - 9-17
AB  - Allogeneic stem cell transplantation (SCT) may cure many patients with 
      hematologic malignancies due to both the intensive conditioning therapy, and in 
      many patients, the potent graft-vs-leukemia (GVL) effect of the donor graft. The 
      GVL effect is mediated in large part by mature T-cells contained in the donor 
      graft and has been defined in detail in animal models of transplantation. The GVL 
      activity has been observed in the clinical setting after SCT from both matched 
      siblings and unrelated donors. The best demonstration and most direct evidence of 
      GVL activity in humans come from the use of donor leukocyte infusions (DLI). For 
      patients who relapse with chronic myelogenous leukemia after matched sibling SCT, 
      infusions of leukocytes collected from the original transplant donor will 
      re-establish complete and durable remission in 60-80% of patients. DLI is less 
      effective for more advanced phases of CML and for patients who relapse with 
      diseases other than CML. DLI after matched sibling SCT is complicated primarily 
      by graft-vs-host disease (GVHD), marrow aplasia, and unfortunately, relapse in 
      some cases. There has been little information regarding the use of unrelated DLI 
      (UDLI). Available data now shows that despite initial concerns that UDLI would 
      result in excessive toxicity, it is an effective approach to relapse after 
      unrelated donor marrow grafting. Response rates are similar to those seen after 
      the use of matched sibling DLI, and many remissions remain durable. Graft-vs-host 
      disease is a frequent complication after UDLI though the incidence and severity 
      of GVHD is also similar to the use of matched sibling DLI. It is not clear that 
      the GVL and GVHD effects can be separated, since the majority of responding 
      patients also develop GVHD. The most effective cell dose for UDLI has not been 
      established, though there does not appear to be either a dose-response or 
      dose-toxicity relationship from UDLI. Although second unrelated donor bone marrow 
      transplantation (BMT) may cure a small minority of patients, GVL induction with 
      UDLI offers a safer and potentially more effective therapy for relapsed leukemia, 
      and offers insights in methods to manipulate the human immune system for 
      therapeutic benefit.
FAU - Leis, Jose
AU  - Leis J
AD  - Bone Marrow and Stem Cell Transplant Program, Oregon Health Sciences University, 
      Portland, USA.
FAU - Porter, David L
AU  - Porter DL
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Leuk Lymphoma
JT  - Leukemia & lymphoma
JID - 9007422
SB  - IM
MH  - *Bone Marrow Transplantation
MH  - Graft vs Leukemia Effect
MH  - Hematologic Neoplasms/*therapy
MH  - Humans
MH  - Leukocyte Transfusion/adverse effects/methods/*standards
MH  - Recurrence
MH  - Transplantation, Homologous
RF  - 55
EDAT- 2002/03/23 10:00
MHDA- 2003/07/30 05:00
CRDT- 2002/03/23 10:00
PHST- 2002/03/23 10:00 [pubmed]
PHST- 2003/07/30 05:00 [medline]
PHST- 2002/03/23 10:00 [entrez]
AID - 10.1080/10428190210202 [doi]
PST - ppublish
SO  - Leuk Lymphoma. 2002 Jan;43(1):9-17. doi: 10.1080/10428190210202.